From the Guidelines
Tranexamic acid (TXA) should not be used as a standard treatment for gastrointestinal (GI) bleeding outside of clinical trials, due to uncertain benefits and potential risks. The role of TXA in managing GI bleeding is still being investigated, with some evidence suggesting a potential benefit in reducing mortality, but this is largely based on older studies with high risk of bias 1. The British Society of Gastroenterology guidelines suggest that TXA may be beneficial in acute GI bleeding, but the evidence is not strong enough to support its routine use 1.
Some key points to consider when evaluating the use of TXA in GI bleeding include:
- The potential benefit of TXA in reducing mortality is uncertain and may not be applicable to modern day care 1
- The risk of thromboembolic events with TXA use in GI bleeding is unknown due to limited study size 1
- TXA is currently being investigated in the HALT-IT trial, and its use in acute LGIB is suggested to be confined to clinical trials pending the results of this study 1
In clinical practice, the use of TXA in GI bleeding should be approached with caution, and alternative treatments such as endoscopy and correction of coagulopathy should be prioritized. If TXA is considered, it should be used with careful monitoring for potential adverse effects, particularly in patients with thromboembolic risk factors.
From the Research
Role of Tranexamic Acid in GI Bleeding
- Tranexamic acid (TXA) has been studied for its potential to manage gastrointestinal (GI) bleeding, with mixed results 2, 3, 4, 5, 6.
- A systematic review and meta-analysis found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper GI bleeding 2.
- Another study found that early administration of TXA may be beneficial in treating upper GI bleeding in the emergency department, but its effects on lower GI bleeding require further clarification 2.
- A double-blind randomized controlled trial found that TXA reduced the need for urgent endoscopy in patients with acute GI bleeding, but did not significantly reduce mortality, re-bleeding, or blood transfusion rates 3.
Efficacy and Safety of TXA in GI Bleeding
- A meta-analysis of randomized controlled trials found that TXA did not improve outcomes in acute upper GI bleeding and may increase the risk of venous thromboembolic events 5.
- Another study found that extended-use high-dose IV TXA did not reduce mortality or bleeding outcomes, but increased adverse events such as deep venous thrombosis, pulmonary embolism, and seizure 4.
- However, a systematic review and individual patient data meta-analysis found that TXA reduced the odds of death by 16% in patients with GI bleeding, and did not increase the odds of vascular occlusive events 6.
Clinical Implications
- The use of TXA in GI bleeding management is still unclear, and further studies are needed to determine its efficacy and safety in different patient populations 2, 3, 4, 5, 6.
- Clinicians should consider the potential benefits and risks of TXA in GI bleeding management, and make informed decisions based on individual patient needs and circumstances 2, 3, 4, 5, 6.